Partial Heart Transplantation Can Provide a Pulsatile and Growing Fontan Conduit: A Rightward Shift for a Better Fontan

The total cavopulmonary connection, more commonly known as the Fontan-Kreutzer procedure, is the final surgical step in the palliation of single ventricle congenital heart defects. The overwhelming success of the Fontan procedure has resulted in a worldwide population of 50,000 to 70,000 patients with a Fontan procedure. However, the resultant Fontan physiology, characterized by parallel systemic and pulmonary circuits, inevitably results in fatal long-term complications as a result of passive, nonpulsatile pulmonary blood flow, inefficient hemodynamics, and static conduit size which are inherent to the Fontan. Partial heart transplantation has dramatically altered the landscape of congenital heart surgery by providing a source of semilunar valve implants with the potential for growth and self-repair. Here we hypothesize that partial heart transplantation can also provide an ideal Fontan conduit characterized by pulsatility, growth potential, low thrombogenicity, and optimal flow dynamics.